Pre-hospital Delay In Patients With Diabetic Foot Problems: Influencing Factors And Subsequent Quality Of Care

Aims To investigate the proportion of delay in reporting their footproblems in diabetic foot patients, examine the possible risk factors andprognosis.Materials and Methods In a retrospective study,270patients withdiabetic foot problems were classified into three groups: those with diabeticfoot duration≤7days were group1, those with diabetic foot duration＞1month were group3, the rest were group2. Compare their demographic andclinical characteristics, laboratory results, treatment data, sequent outcomes(hospital stays, amputation rate and mortality), and analysis the factorsinfluencing patients pre-hospital delay.Results270patients were enrolled in our study, their mean time tohospital presentation was46.49days. A total of77(28.5%) patients arrivedwithin one week,106(39.3%) patients between one week and one month,and87(32.2%) patients arrived longer than one month after symptom onset.Among numerous factors, we found nine variables were associated with longpre-hospital delay according to univariate analysis (P＜0.05), they were no previous ulcer, no health insurance, bad housing conditions, low incomelevel, low education level, seldom foot inspection, few follow up, absence ofdiabetic foot education and lack of the knowledge of foot lesion dangersignal. Multivariate logistic regression analysis indicated that never receiveddiabetic foot education (OR2.70[95%CI1.03-7.06], P=0.043) and lack ofdiabetic foot knowledge (OR2.14[95%CI1.16-3.94], P=0.015) wereindependent factors for patients pre-hospital delay. Our study also showedthat pre-hospital delay was an important risk factor leading to amputation(OR2.22[95%CI1.36-3.64]，P=0.002) and mortality (OR2.69[95%CI1.35-5.33]，P=0.005).Conclusions Long pre-hospital delay is most marked in those groupsknown to: no previous history, low socio-economic status, seldomperformance of foot inspection, few follow up, never received diabetic footeducation and lack of knowledge of foot lesion danger signal; and thesedelay is likely to be significant contributor to these poorer outcomes, lowerextremity amputation and mortality. Considerations should be given todeveloping a community intervention program targeting at risk communitiesto encourage earlier assessment directed by the multidisciplinary teamservice, to reduce disparity and improve foot outcomes.